The beauty gamble

'You'll feel a little sting,' warns Dr Rita Rakus, looming over me with her syringe. My upper lip has been rubbed with anaesthetic cream, but there's still a sharp prick and a slightly unpleasant stretching sensation as she injects the gel into the corner of my mouth. My eyes fill up, but she works fast, delivering ten further jabs along my nose-to-mouth lines in barely a minute. 'Now, what do you think?' she says, handing me a mirror.

The face staring back at me definitely looks different. The lines have miraculously faded and the corners of my mouth now turn up, rather than down, in repose.

'Our motto is: five years younger in five minutes!' says Dr Rakus, cheerfully.

I'm on a high when I leave her Knightsbridge surgery, and ever since, people have been telling me I look rested or asking me if I've just been on holiday.

Quick, almost painless and subtly effective - it isn't surprising that dermal filling treatments, like the one I've just had, have become hugely popular.

Wigmore Medical, the company that supplies the majority of the UK's dermal fillers, estimates that demand has gone up by around 200 per cent in the past year alone. And for a certain well-groomed sector of London society, getting regular jabs has become as routine as a hairdo. The prices are even comparable. It might cost you £300 to get your lips done - slightly less than the cost of a cut-andblowdry from hairdresser Nicky Clarke - while the effects last up to a year or even more. But is it too good to be true?

In some cases, yes. These cosmetic procedures aren't always quite as trouble-free as they are presented. One wonders how many women would still be happy to have their injections if they knew that what was being pumped into their skin might be anything from discarded babies' foreskins (Cosmoplast and CosmoDerm), mashed-up cockscombs (Hylaform) or freezedried human cadaver tissue (AlloDerm).

And stomach-churning though this is, there is a more serious issue. In a few cases, dermal fillers can cause an allergic reaction that may leave you scarred for life.

It's a situation that leaves Dr Rakus, the cofounder of the British Association of Cosmetic Doctors, extremely concerned. 'Some of the permanent fillers get passed for use in the EU with comparatively little in the way of clinical trials,' she says. 'We're now finding that patients can get a reaction two or three years down the track.'

Dr Rakus refuses to use any new product until it has been on the market for at least five years and sticks to collagen (which requires a prior allergy test) and the semi-permanent hyaluronic acid products Perlane and Restylane, which, as hyaluronic acid occurs naturally in the body, have a low rate of reaction - currently one in 5,000, according to Dr Rakus.

'And if there is a problem, at least you know it's going to go away in a few months, and it's easier to resolve the situation,' she says. 'The risk of permanent damage is much lower.'

Dermal fillers are used to plump up the skin (unlike the betterknown Botox, which is used to paralyse the frown muscles to decrease the appearance of lines). Fillers are injected into wrinkles to smooth them out; used in the lip-line, they can increase the size or correct the shape of the pout.

Semi-permanent fillers are made from collagen, or the naturally occurring substance hyaluronic acid, which may be made in the laboratory through a bacterial fermentation procedure, or extracted from cockscombs. Permanent fillers are a mix of either of these substances with a non-degradable substance, such as acrylic fragments or ground-up contact lenses, which stay under the skin and keep the lines at bay for longer.

But in a small number of cases, the patient can develop a reaction to the implant. The skin can reject them or encapsulate around them, forming hard lumps that may be painful or red.

And, unlike breast implants, these tiny beads are difficult to remove. If steroid injections don't calm the reaction, they may have to be dug out, which could leave a scar far more unsightly than a wrinkle could ever have been.

In October, the General Medical Council heard a testimony from one patient, Rosaline McGhee, a businesswoman in her thirties from Hockley, Essex. She had attended the French Cosmetic Medical Company in Wimpole Street - a clinic run by Dr Jean-Louis Sebagh, one of London's best-known cosmetic surgeons - and asked for a minor lip enhancement from his then colleague Dr Bernard Hertzog.

She was injected with a permanent filler called Dermalive, which is made from hyaluronic acid and plastic granules. But after the injection, McGhee suffered an allergic reaction. Her mouth distorted and her lips began to blister. Almost two years after her treatment, her mouth still felt sore and 'like elastic', she told the council. Dr Hertzog was cleared of serious professional misconduct but was found to have acted below the standards of care expected.

McGhee isn't the only patient to have had problems with Dermalive. Jenny White (not her real name) wanted to keep her lines at bay. At 55, a glamorous international businesswoman, she felt she owed it to herself. Now, she has sore, hard lumps in her skin which keep her awake at night with the pain, and is considering surgery to have the filler scraped from under her skin.

Ironically, she chose filler injections because she was too frightened of possible complications to have a facelift. Nevertheless, she was concerned enough to ask her doctor, a reputable Londonbased cosmetic surgeon, if she might have an allergic reaction. 'He said he had never heard of one.' She was given two injections, six months apart.

At first, Jenny was delighted with the results. 'I looked fantastic,' she recalls. She congratulated herself on choosing a permanent product which would keep her skin looking young for years.

But just three months after her final injection, the permanence of the implant was to become a major disadvantage. She woke up one morning and noticed a sore, hard lump in her skin where the product had been injected. 'I thought it might be scar tissue,' she says. But the lump grew bigger and other lumps appeared. Her skin became red and puffy, and she had to resort to covering make-up. 'I looked like a Cabbage Patch doll,' she says. A year on, a regime of weekly cortisone injections has stabilised her condition. But her face shape has changed. 'It's puffy, and my mouth has been pushed out of